The Condition Gap
By Dr Amy Cleese
It seems obvious that our physical and mental state would affect our sex lives.
How many times have you said you didn’t feel in the mood, felt distracted, felt too tired or bloated?
What about if…
Your skin was Itchy? Sore? Inflamed?
Your joints were stiff and painful? Certain positions were off limits?
You had vulval pain or were fearful that your vagina would involuntarily spasm?
Your bowels were erratic, you were having blood in your poo or were worried you would feel the need to go during sex?
You had surgery and were too nervous to ask up when you could next have sex and no one had brought it up with you?
What if you were dying and longed to be physically close to someone you loved?
What if you had never been considered as a 'sexual person' in the eyes of those who give sex education, treat sexual health or dictate sexual policy?
If you are someone who receives anal sex then an anal fissure, haemorrhoids or a flare of proctitis (inflammation of the lining of the rectum) is going to have a much larger impact on your quality of life and overall sexual wellbeing than for others - would questions re: anal sex commonly be asked in a medical appointment?
It makes complete sense that physical or mental health conditions have an impact on sexual wellbeing.
The evidence backs this up too.
If you look up most health conditions and sex and you can find research papers showing there is an increase in sexual dysfunction, impact on body image and/or decreased satisfaction/pleasure due to the condition. The fact it is being researched is fantastic (happy to provide references). After all sex is one of our basic physiological needs as described in Maslow’s hierarchy.
It is therefore necessary to define the phenomena we are seeing more broadly.
If we take inspiration from the widely cited and very effective ‘gender gap’ describing “an undesirable or unfair difference between men and women in terms of opportunities, pay, status and sexual pleasure”
It is clear that what we are seeing is a ‘condition gap’ - we have defined this as:
“The systemic inequality in sexual wellbeing between those with physical and mental health conditions, taking into account the biassed societal structures in which we live”
Many life-changing condition based charities have excellent resources talking about sex and online resources are one of the quickest and easiest ways to address health concerns.
But the taboo around this topic is what limits further progression and by keeping it online the taboo remains. Health professionals need to be able to talk comfortably and easily about sex with their patients; no matter the person sitting in front of them and no matter their sexual preferences.
Primary care doctors see people with every type of condition, symptom, background and therefore we want to explore if primary care is best placed to bring up sexual wellbeing as standard practice. One question could make all the difference to people feeling more comfortable in their bodies and talking about sex.
The ‘condition gap’ is a vast, diverse, complex gap but with an equally diverse group of people with unique skill sets on board we can improve sexual wellbeing for everybody and every body.
References
Afsar FS, Seremet S, Demirlendi Duran H, Karaca S, Mumcu Sonmez N. Sexual quality of life in female patients with acne. Psychol Health Med. 2020 Feb;25(2):171-178. doi: 10.1080/13548506.2019.1679845. Epub 2019 Oct 22. PMID: 31635480.
Gleeson A, Hazell ESexual well-being in cancer and palliative care: an assessment of healthcare professionals’ current practice and training needsBMJ Supportive & Palliative Care 2017;7:251-254.
Navarro-Sánchez, A., Luri-Prieto, P., Compañ-Rosique, A., Navarro-Ortiz, R., Berenguer-Soler, M., Gil-Guillén, V. F., Cortés-Castell, E., Navarro-Cremades, F., Gómez-Pérez, L., Pérez-Tomás, C., Palazón-Bru, A., Montejo, A. L., & Pérez-Jover, V. (2021). Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case–Control Study. Journal of Clinical Medicine, 10(19). https://doi.org/10.3390/jcm10194401
Pithavadian R, Chalmers J, Dune T. The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Womens Health (Lond). 2023 Jan-Dec;19:17455057231199383. doi: 10.1177/17455057231199383. PMID: 37771119; PMCID: PMC10540594.
Sex and cancer | Impact on your sex life and relationships (no date). https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sex-and-cancer. (accessed 13/8/24)
Sex and relationships and Crohn’s Disease or Ulcerative Colitis (IBD) (no date). https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/living-with-crohns-or-colitis/sex-and-relationships#:~:text=Pain%20can%20be%20your%20body,and%20where%20you%20feel%20pain. (accessed 13/8/24)
Tristano AG. Impact of rheumatoid arthritis on sexual function. World J Orthop. 2014 Apr 18;5(2):107-11. doi: 10.5312/wjo.v5.i2.107. PMID: 24829873; PMCID: PMC4017303.